The dual risks of unwanted pregnancy and HIV/AIDS : the case of KwaZulu-Natal, South Africa

This thesis is divided into two parts. The broad aim of the first part of the study is to provide insights into the perspectives and behaviour of sexually active individuals and couples with regard to the prevention of unwanted pregnancy and HIV/AIDS in KwaZulu-Natal, South Africa. A combination of qualitative and quantitative data is used: focus group discussions, a survey of individuals and couples and in-depth interviews. The study found that knowledge of family planning is virtually universal. Most men and women approve of family planning as a method of fertility regulation, although women are more likely than men to report using a method of family planning. Family planning is seen as the woman's domain and as a result, the wife often takes the initiative in using a method of family planning, sometimes without her husband's knowledge. With regard to HIV, awareness is also virtually universal among men and women. Despite this, there is much resistance to condom use especially in marital unions. Condoms are more likely to be used in non-marital than marital unions. However, there are some encouraging indications that condom use in marital unions is occurring and the wife's risk perception is a major factor influencing use. In the second part of the study, the emphasis shifts from the perspectives of individuals to the role of services. The broad aim of this part of the study is to consider how health services are responding to the needs of sexually active men and women by obtaining information from providers and clients. The study found that while condom promotion is an important component of integrated services, it is not consistently undertaken by providers. Moreover, in most health facilities, clients are only usually offered services for which they present at the health facility. Clients feel that they would benefit from additional information that will protect them against the dual risks of unwanted pregnancy and STIs/HIV.